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Text / Liu Yixuan

4-year-old Rui Rui has been suffering from heat cramps due to fever since she was 8 months old. In addition, her mother also found that Rui Rui’s development is gradually not keeping up with children of the same age, and she is usually reluctant to talk. But the family believes that Rui Rui was sick too often when he was a child, and will catch up slowly when he grows up.

After entering kindergarten, Rui Rui had more frequent heat cramps, and even when there was no fever, convulsions occurred. The kindergarten teacher also reported to her mother that Rui Rui did not interact much with her classmates at school, her personality was stubborn, and she was emotionally unstable. She suggested that her mother take Rui Rui to the hospital for evaluation by a doctor.

Please read on…

Is Rui Rui’s condition just a heat cramp? Heat cramps are most common between the ages of 6 months and 5 years, and are most common between the ages of 1 and 2. The main symptoms are fever plus convulsions, and CNS infection is excluded. It usually occurs on day 1 of the fever, and most of it resolves on its own within 1 to 2 minutes. Heat cramps are generally benign, improve with age, and usually do not cause neurological impairment or intellectual or behavioral problems.

Rui Rui’s age is indeed in line with the age at which heat cramps are likely to occur, but Rui Rui had developmental delays and behavioral and emotional problems. Later, she had convulsions even without fever. It is indeed not a typical manifestation of heat cramps. Professional assessment.

◎What is heat-sensitive epilepsy?

Heat-sensitive epilepsy, as the name suggests, is a type of epilepsy that is characterized by being very sensitive to temperature, and an increase in body temperature may trigger epilepsy (for example, taking a hot bath, increasing body temperature after exercise). Unlike heat cramps, convulsions do not just occur with fever, they can occur in any condition, and a high percentage can affect neurological development, requiring antiepileptic drugs to control the disease.

Dravet syndrome is a heat-sensitive epilepsy disease. It is a severe epileptic encephalopathy caused by gene mutation. It is a rare disease. Most of the first seizures occur before the age of 1, often accompanied by fever. I thought it was just heat cramps, but after the onset, developmental delay, language and cognitive impairment, abnormal gait, and behavioral problems began to appear.

Epilepsy in Zhuofei syndrome is mostly intractable and requires simultaneous treatment with several antiepileptic drugs.

◎My child has heat cramps, when should I suspect the possibility of epilepsy?

●Convulsion time is too long (greater than 15 minutes).

● Unilateral asymmetric limb twitching or unilateral limb weakness after the seizure.

● Multiple convulsions in a single febrile episode.

● age of onset is less than 6 months or older than 5 years.

●Presence of growth retardation or neurological abnormalities.

● have a family history of epilepsy.

(The author is the attending physician of the Department of Pediatric Neurology, Chang Gung Memorial Hospital, Linkou)

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